• Ms.

MONIKA MINHAS
 VITAL SIGNS

Vital signs are measures of various physiological status, in order to assess the most
basic body functions. When these values are not zero, they indicate that a person is
alive.

All of these vital signs can be observed, measured, and monitored. This will enable
the assessment of the level at which an individual functioning. Normal ranges of
measurements of vital signs change with age and medical condition.

Vital signs are useful in detecting or monitoring medical problems. Vital signs can
be measured in a medical setting, at home, at the site of a medical emergency, or
elsewhere.
 TEMPERATURE

• The normal body temperature for a healthy adult is approximately 98.6 degrees
Fahrenheit/37.0 degrees centigrade. The human body temperature typically ranges
from 36.5 to 37.5 degrees centigrade (97.7 to 99.5 degrees Fahrenheit).

• Health care providers use the axillary, rectal, oral, and tympanic membrane most
commonly used to record body temperature, and the electronic and infrared
thermometers are the devices most commonly used.
 Sites for measurement of body temperature
• Oral temperature: It is the most commonly used method, is considered very
convenient and reliable. Here we place the thermometer under the tongue and close
the lips around it. The posterior sublingual pocket is the area that gives the highest
reliability.
• Tympanic temperature: In this method, the thermometer is inserted into the ear canal.
This site is convenient but less accurate and hence not recommended.
• Axillary temperature: In this, we place the thermometer in the axilla while adducting
the arm of the patient. This site is convenient but generally considered less accurate
and hence not recommended.
• Rectal temperature: The thermometer is inserted through the anus into the rectum
after applying a lubricant. This method is very inconvenient, but since it measures
the internal measurement, it is very reliable.It is usually considered the "gold
standard" method of recording temperature.
 PULSE RATE

• Pulse rate is defined as the wave of blood in the artery

created by contraction of the left ventricle during a cardiac
cycle.

• Central Pulses
• Peripheral pulses
• Pulse deficit

Pulse deficit is the difference in the apical pulse and the radial pulse.
These should be taken at the same time, which will require that 2
people take the pulse. One with a stethoscope and one at the wrist.
Count for 1 full minute. Then subtract the radial from the apical. This
is the Pulse Deficit.
Parameters for assessment of pulse

1. Rate: The normal range used in an adult is between 60 to 100 beats /minute with rates
above 100 beats/minute and rates and below 60 beats per minute, referred to as
tachycardia and bradycardia, respectively. Changes in the rate of the pulse, along with
changes in respiration is called sinus arrhythmia. In sinus arrhythmia, the pulse rate
becomes faster during inspiration and slows down during expiration.

2. Rythym: Assessing whether the rhythm of the pulse is regular or irregular is essential.
The pulse could be regular, irregular, or irregularly irregular. Irregularly irregular
pattern is more commonly indicative of processes like atrial flutter or atrial fibrillation.
 to be conti...
3. Volume: Assessing the volume of the pulse is equally essential. A low volume pulse
could be indicative of inadequate tissue perfusion; this can be a crucial indicator of
indirect prediction of the systolic blood pressure of the patient.

4. Symmetry: Checking for symmetry of the pulses is important as asymmetrical pulses

could be seen in conditions like aortic dissection, aortic coarctation, Takayasu arteritis,
and subclavian steal syndrome.

5. Amplitude and rate of increase: Low amplitude and low rate of increase could be
seen in conditions like aortic stenosis, besides weak perfusion states. High amplitude
and rapid rise can be indicative of conditions like aortic regurgitation, mitral
regurgitation, and hypertrophic cardiomyopathy.
Parts of Stethoscope
 Respiration

• The respiratory rate/the number of breaths per minute is defined as the

one breath to each movement of air in and out of the lungs. The normal
breathing rate is about 12 to 20 breath per minute in an average adult. In
the pediatric age group, it is defined by the particular age group.
 Factors Affecting Respiration

1. Pain, anxiety, exercise .

2. Medications .
3. Trauma .
4. Infection.
5. Respiratory and cardiovascular disease .
6. Alteration in fluids, electrolytes, acid- base balances.
Parameters
1. Rates:
zRates higher or lower than expected are termed as tachypnea and bradypnea,
respectively. Tachypnea described as a respiratory rate more than 20 beats per
minute could occur in physiological conditions like exercise, emotional changes,
pregnancy, and pathological conditions like pain, pneumonia, pulmonary
embolism, asthma, etc. Bradypnea which is ventilation less than 12
breaths/minute can occur due to worsening of any underlying respiratory
condition leading to respiratory failure or due to usage of central nervous
system depressants like alcohol, narcotics, benzodiazepines, or metabolic
derangements. Apnea is the complete cessation of airflow to the lungs for a
total of 15 seconds which may appear in cardiopulmonary arrests, airway
obstructions, the overdose of narcotics and benzodiazepines.
2. Depth of breathing:
Hyperpnea is described as an increase in the depth of breathing. Hyperventilation,
on the other hand, is described as both an increase in the rate and depth of
breathing and hypoventilation describes the decreased rate and depth of
ventilation. Depth of breathing involves what muscle groups they are using—for
example, the sternocleidomastoid (accessory muscles) and abdominal muscles—
the movement of the chest wall in terms of symmetry. The inability to speak in full
sentences or increased effort to speak is an indicator of discomfort when breathing.
3. The pattern of breathing:
There are many conditions which are based on the variation in the pattern of
breathing. Biot’s respiration is a condition where there are periods of
increased rate and depth of breathing, followed by periods of no breathing or
apnea.
Cheyne-Stokes respiration is a peculiar pattern of breathing where there is an
increase in the depth of ventilation followed by periods of no breathing or
apnea.
Kussmaul’s breathing refers to the increased depth of ventilation, although
the rate remains regular.
Orthopnea refers to difficulty in respiration occurring on lying horizontal but
gets better when the patient sits up or stands.
Paradoxical ventilation refers to the inward movement of the abdominal or
chest wall during inspiration, and outward movement during expiration,
which is seen in cases of diaphragmatic paralysis, muscle fatigue, trauma to
the chest wall.
 Blood Pressure
• Blood pressure is the force of circulating blood on the walls of the arteries, mainly in
large arteries of the systemic circulation. Blood pressure is taken using two
measurements: systolic (measured when the heartbeats, when blood pressure is at its
highest) and diastolic (measured between heartbeats, when blood pressure is at its
lowest). Blood pressure is written with the systolic blood pressure first, followed by
the diastolic blood pressure.
• The direct measurement of BP requires an intra-arterial assessment but it is not
practical in clinical practice so BP is measured via non-invasive means. Earlier BP is
measure with a stethoscope while watching a sphygmomanometer (i.e auscultation).
However, semiautomated and automated devices that use the oscillometry method,
which detects the amplitude of the BP oscillations on the arterial wall, have become
widely used over the past 2 decades.

• The brachial artery is the most common site for BP measurement.

Sphygmomanometer
 Key Points for Accurately Measuring BP

All healthcare providers should be aware of making sure all the following pre-requisites
are met before checking the blood pressure of the patient.
The patient should:

• Not have taken any caffeinated drink at least 1 hour before the testing and should not
have smoked any nicotine products at least 15 minutes before checking the pressure.
• They should have emptied their bladder should be before checking the blood
pressure. Full bladder adds 10 mm Hg to the pressure readings.
• It is advisable to have the patient be seated for at least 5 minutes before checking
his/her pressure. This step takes care of or at least minimizes the higher readings that
could have occurred secondary to rushing in for the clinic appointment.
• The providers should not be having a conversation with the patient while checking
his blood pressure. Talking or active listening adds ten mmHg to the pressure
readings.
• The patient’s back and feet should be supported, and their legs should be uncrossed.
Unsupported back and feet add six mmHg to the pressure readings. Crossed legs add
2 to 4 mmHg to the pressure readings.
• The arm should be supported at the heart level. Unsupported arm leads to 10 mmHg
to the pressure readings. The patient’s blood pressure should get checked in each
arm, and in younger patients, it should be tested in an upper and lower extremity to
rule out the coarctation of the aorta.
• Cuff placement should be on a bare arm and not put over sweaters, coats, or other
clothing. Using the correct cuff size is very important. Smaller cuff sizes give falsely
high, and larger cuff sizes give a falsely lower blood pressure reading
 Measuring Pain Scales

1. Numerical rating scales: These measure pain on a scale of 0–10, where 0

means no pain at all, and 10 represents the worst pain imaginable. It is
useful for gauging how pain levels change in response to treatment or a
deteriorating condition.

2. Verbal descriptor scale: This scale may help a doctor measure pain levels
in children with cognitive impairments, older adults, autistic people, and
those with dyslexia. Instead of using numbers, the doctor asks different
descriptive questions to narrow down the type of pain.
 PAIN
• Pain is an unpleasant sensation and emotional experience usually caused
by tissue damage. It allows the body to react to and prevent further tissue
damage.
3. Faces scale: The doctor shows the person in pain a range of expressive faces
from distressed to happy. Doctors mainly use this scale with children. The
method has also shown effective responses in autistic people.

4. Brief pain inventory: This more detailed written questionnaire can help doctors
gauge the effect of a person’s pain on their mood, activity, sleep patterns, and
interpersonal relationships. It also charts the timeline of the pain to detect any
patterns.

5. McGill Pain Questionnaire (MPQ): The MPQ encourages people to choos

wordsTrusted Source from 20 word groups to get an in-depth understanding of
how the pain feels. Group 6, for example, is “tugging, pulling, wrenching,” while
group 9 is “dull, sore, hurting, aching, heavy.”
Pain Rating Scale
https://youtu.be/JpGuSxDQ8js